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Physiotherapy lccw
| Question | Answer |
|---|---|
| Physiological effects of massage | increases: blood flow, heart rate, blood pressure, breaks adhesions, removes lactic acid decreases: edema, congestion, sedates nerves |
| indications for massage | Subacute phase, strains, sprains, tendinitis, bursitis |
| Contraindications for massage | Acute inflammation, ulcerations, thrombosis, varicosities, phlebitis |
| types of massage | effleurage (stroking), petrissage (kneading), tapotement (percussion), vibration (shaking), pressure (nimmo, trigger points) |
| What does transverse friction massage do | breaks adhesions, decreases chemical cross linking, good for sp/st/bursitis/tendonitis bad for calcific tendinitis |
| For which of the following conditions would transverse friction massage be inappropriate | Bursitis, chronic sprain, thrombophlebitis, TFM is appropriate for all the above? Thrombophlebitis |
| What are the 2 primary supports to remember | soft collar, lumbar support |
| What is a soft collar used for | soft tissue injuries, primarily during acute phase |
| What is a hard collar or halo used for | cervical fractures & instability (think philadelphia, poster, somi, & CTO) |
| What is a lumbar support used for, when should you remove it | To increase intra-abdominal pressure remove when not lifting |
| What may all braces aid in | reduce mobility, provide support, correct posture or position, & relieve stress by supporting muscles & ligaments |
| What are the indications for using braces | provide functional support, joint instability, sp/st, pain |
| what are the contraindications for using braces | may promote adhesions or atrophy |
| what brace is used for scoliosis | Milwaukee |
| what is an SI girdle used for | goes around hips, used for SI hypermobility, |
| What is an AKA for an SI girdle | trochanteric belt |
| What is a cock-up splint used for | CTS |
| What does a lennox-hill brace do | knee brace for de-rotation |
| What is a figure-eight brace | an inversion ankle-sprain brace |
| what is an AKA for a figure-eight brace | Louisiana strap |
| what are the indications for vibratory therapy | adhesions, trigger points, spacticity, headaches(occipital),bronchial congestion, circulatory stasis, constipation, depression, edema, myalgia, joint swelling, intestinal stasis |
| what are the contraindications for vibratory therapy | acute inflammation, acute LBP, advanced heart disease, thrombophlebitis, pneumothorax, over sensitive tissue, near damaged organs, malignancies, fractures, hemorrhagic conditions, bony prominences, lyphangitis, & cervical spondylosis |
| How many settings are there for vibratory therapy & what are they | 3: low, med, & high |
| what type of application do you use in vibratory therapy for a superficial affect | parallel application |
| what type of application do you use in vibratory therapy for a deep affect | percussion |
| in vibratory therapy what organ do you work towards | the heart |
| in vibratory therapy, when should you stop treatment | if excessive redness or itching occurs |
| how long do you apply vibratory therapy for localized pain | less than 10 minutes |
| how long do you apply vibratory therapy for trigger points | 6-8 minutes |
| how long do you apply vibratory therapy for muscle relaxation | 2-10 minutes |
| how long do you apply vibratory therapy for postural drainage | 3-15 minutes |
| how long do you apply vibratory therapy for body relaxation | 3-5 minutes |
| how long do you apply vibratory therapy with cold | 10-12 minutes |
| what are the physiological effects of traction | decrease intradiscal pressure, increase IVF, break adhesions, straighten curve, reduce muscle spasm, create gliding of facets |
| what are the indications for traction | disc syndromes, foraminal encroachment, hyperlordosis, chronic muscle spasms, & adhesions |
| what are the contraindications for traction | bone weakening conditions (ricketts, osteoporosis), presgnancy (particularly intermittent), RA, acute muscle spasms, fractures, hypertensive disorders |
| For cervical traction, what weight do you start with; whats the max | 5% of BW & increase 2 lbs. each treatment to a max of 40 lbs. |
| What amount of flexion do you traction for C2-C6 | 25-28 degrees |
| For occiput-C1 how much flexion do you traction | none, 0, nada |
| How many lbs. does it take to overcome the weight of the skull | at least 10 lbs. |
| For lumbar traction, what weight do you start with; whats the max | start with 25% of BW, increase up to 5 lbs. each treatment. Max 150 lbs. |
| what is gouchers position | lumbar traction: supine with legs flexed |
| when should you stop treatment of traction | if patient experiences dizziness, nausea, or discomfort |
| what position is the patient in frequently during traction | horizontal; almost always in flexion (not extension) |
| the weight of the initial lumbar traction should be what percent of the patients body weight | 25 |
| What is cardiovascular exercise | vigorous exercise that results in 50-85% maximum oxygen consumption & heart rate of 60-90% max for 15-60 minutes cyclic exercise with large muscles |
| what is the formula for MHR (max heart rate) | 220-age exercise at 60-85% |
| what is the karvonen formula | THR=RHR + .6(MHR-RHR) THR= training heart rate RHR= resting heart rate MHR= maximum heart rate |
| what are the three main types of contractions | isometric, isotonic, & isokinetic |
| what is an isometric contraction | a contraction without movement. Good for early rehab |
| what can an isometric contraction help with | pumping edema |
| what is an isotonic contraction | a contraction with fixed resistance & variable speed |
| what are the 2 types of isotonic contractions | concentric & eccentric |
| what is a concentric isotonic contraction | contraction with shortening (fixed resistance, variable speed) |
| what is an eccentric contraction | contraction with lengthening (fixed resistance, variable speed) |
| what is an isokinetic contraction | fixed speed, variable resistence No eccentric |
| what is an agonist | a prime mover |
| what is an antagonist | opposes prime mover |
| what is a synergist | aids the agonist |
| what is a stabilizer | supports the articulation during movement |
| what is the neutralizer | offsets negative effects of movement |
| what are buerger-allen exercises | exercises for patients w/ peripheral vascular disease (raynaud's buerger's) |
| How many times are Buerger-Allen exercises done for & in what position | 6-7 times in a sitting position, several times/day |
| What is a procedure for buerger-allen | 1. support legs in elevated position at 60-90 degrees for 30-180 seconds ( or until extremity becomes blanched) patient is instructed to actively dorsiflex & plantarflex the ankle |
| What is a procedure for buerger-allen | 2. have feet dangle over edge of bed for 2-5 mins or until hyperemia is seen, then add one min. (should not exceed 5 mins) |
| What is a procedure for buerger-allen | PLace legs in horizontal position for 3-5 mins |
| what is codman's exercises | exercise to strengthen shoulder girdle (cuff muscles) while avoiding supraspinatus use, pendulum exercises |
| what are kegal exercises | post partum/while pregnant or urinary incontinence pelvic floor muscle exercises. |
| what are jacobson's exercises | relaxation exercises to reduce muscle tension, use biofeedback centers, skin detectors to measure stress |
| what are Borbarths exercises | knee exercises for vastus medialis & vastus lateralis |
| what are claytons exercises | crawling exercises to mobilize the spine & strengthen muscles for scoliosis |
| what is the delorme protocol | progressive strengthening 1 x 10 at 50%, 10 rep max 1 x 10 at 75% 1 x 10 at 100% |
| Williams (vs McKenzies) | flexion, emphasis on strengthening abs & glutes (ie sit ups, deep squats), could be used for lower crossed syndrome |
| McKenzie's (vs williams) | extension, can be used in acute stage-passive positioning, three syndromes: postural, dysfunctional, & derangement |
| Open chain (vs closed) | exercises performed with hand or foot free to move, usually non-weight bearing, resistance applied at distal end of limb, bench press, curls, leg raises, leg extensions... |
| Closed chain (vs open) | Exercises where the hand or foot cannot move, usually weight-bearing, hand or for usually in contact with a surface, push-ups, pull-ups, squats, leg press... |
| which can be used for lower crossed syndrome, williams or mckenzies | williams |
| which uses passive positioning, williams or mckenzies | mckenzies |
| which is extension more used, williams or mckenzies | mckenzies |
| usually non-weight bearing; open or closed | open |
| exercises where the hand or foot cannot move; open or closed | closed |
| resistance is applied at the distal end of limb; open or closed | open |
| bench press, curls, leg raises, & leg extensions are examples of; open or closed | open |
| push-ups, pull-ups, squats, & leg press are examples of; open or closed | closed |
| what are the 3 common exercises for the TVA | drawing-in maneuver, ab hollowing, & abdominal bracing |
| what is the training emphasis in plyometrics | power |
| what is the formula for power | force x speed= power |
| what is the basic movement of plyometrics | rapid eccentric contraction followed by rapid concentric contraction |
| Clap push-up is an example of | plyometrics |
| what is defined as 1 RM | strength |
| which of the following may be defined as the maximum force that can be exerted during muscle contraction: endurance, strength, power, torsion | strength |
| which of the following muscles is most appropriate for selective strengthening to treat chondromalacia patella: vastus intermedius, medialis, lateralis, rectus femoris | vastus medialis |
| what muscles are tight in upper-crossed syndrome | pec major, pec minor, levator scap, teres major, upper trap, ant deltoid, subscap, lat, teres major, scm, scalenes, rectus capitus |
| what muscles are long/weak in upper-crossed syndrome | rhomboids, lower trap, serratus ant, post deltoid, teres minor, infraspinatus, post deltoid, longus coli & capitus |
| What are the main tight muscles in lower-crossed syndrome | psoas, rectus femoris, erector spinae, QL, & piriformis |
| what are the long/weak muscles in lower-crossed syndrome | abs, glut max, glut med |
| which of the following protocols would be best to address a patient with lower-crossed syndrome: mckenzie, delorme, codman, williams | williams |
| what is the action of the cervical spine strengthening | flexion, extension, l/r lateral flexion, l/r rotation |
| what is the motion of cervical spine strengthening when seated | pt isometrically contracts neck into their own hand or dr's hand using the motion in which the neck needs to be strengthened |
| what is the motion of cervical sprine strengthening when using the neck-sys system | seating/standing. pt contracts neck into the apparatus at the appropriate height into the direction in which the neck needs to be strengthened |
| what are the actions of the cervical spine strength test | flexion, extension, l/r lat flexion, l/r rotation |
| what is the pt position & procedure for the cervical spine strength test | seated, dr directs pt to perform the 6 ROM grade muscle strength; perform bilaterally |
| what is the amount of degrees expected for the cervical ROM observed in a cervical spine length test | flexion 45-60 extension 55 l/r lateral flexion 40 l/r rotation 70-90 |
| what are the external rotators of the shoulder | teres minor & infraspinatus |
| what is the position for stengthening of the external rotators of the shoulder | pt at 90 degrees to door, pt holds tubing in hand furthest from door, elbow bent at 90 degrees, elbow placed firmly into side of body & not allowed to move |
| what is the motion for strengthening of the external rotators of the shoulder | pt pulls tubing away from the midline of the body until they have externally rotated as far as they can |
| what is the position for the strength test of the external rotators of the shoulder | pt face up, pt arm at 90 degrees horizontal abduction w/ arm still on table surface or w/ dr support off table, pt arm pointing straight up to ceiling |
| what is the motion & observation of the ext rotator of the shoulder strength test | dr provides resistance in the direction of internal rotation obs: grade muscle strength; perform bilaterally |
| when muscles are out of balance the stronger muscles will cause | misalignment & undue stress to that particular region of the body |
| what are the hip flexors | iliopsoas, rectus femoris, TFL, & sartorius |
| what are the hip extensors | glut maximus, semi-t, semi-m, biceps femoris |
| an upward pull on the pelvis anteriorly causes what kind of tilt | posterior |
| an upward pull on the pelvis posteriorly causes what kind of tilt | anterior |
| which group of muscles causes anterior pelvic tilt? | low back: erector spinae, QL, etc Hip flexors: rectus femoris, TFL,sartorius, & iliopsoas |
| which group of muscles causes posterior pelvic tilt | abdominals hip extensors: gluts, hamstrings |
| what are the hip abductors | gluteus medius & minimus |
| what are the 5 muscle testing criteria | reliable, valid, measurable, practical, useful |
| what is a grade 5 muscle strength | complete ROM against gravity w/ full resistance |
| what is a grade 4 muscle strength | complete ROM against gravity w/ some resistance |
| what is a grade 3 muscle strength | complete ROM against gravity |
| what is a grade 2 muscle strength | complete ROM with gravity eliminated |
| what is a grade 1 muscle strength | no joint motion, but evidence of slight contractility |
| what is a grade 0 muscle strength | no joint motion, no evidence of contractility |
| what is functional muscle testing | dr observes pt's ability to perform task |
| what is the functional muscle testing for the quads | L2-L4 squat & rise |
| what is the functional muscle testing for the anterior tibialis | L4 heel walk w/ inversion |
| what is the functional muscle testing for the extensor hallicus longus | L5 heel walk |
| what is the functional muscle testing for the peroneals | S1 walk on medial side of foot (eversion) |
| what is the functional muscle testing for the gastroc-soleus | S1 toe walk-rise up & down on toes, bounce on toes |
| what is the functional muscle testing for the gluteus maximus | S1 rise from a seated position without hands |
| what are the 4 things that should be considered when stretching | patient comfort, isolate muscle as best as possible, perform stretch in the opposite direction of muscle contraction & along the muscle fibers, do not injure joints |
| what is the procedure for passive stretching | Hold stretch 15-30 sec rest 30-60 sec repeat 3-5 times |
| what is the procedure for contract-relax (CR) stretching | contract muscle(s) for 5-10 sec; isometric relax 1-2 sec passive stretch 15-30 s rest 30-60 s repeat 3-5 times |
| what is the procedure for reciprocal inhibition (RI) stretching | contract antagonist, opposite muscle from muscle being stretched; isotonic contraction hold 15-30s rest 30-60s repeat 3-5 times |
| what is the procedure for contract-relax-contract (CRC) stretching | contract muscle 5-10s; isometric contraction relax 1-2s contract antagonist; isotonic contraction hold 15-30s rest 30-60s repeat 3-5 times |
| when may strengthening begin | once the pt is properly stretched |
| what is done in a typical rehab protocol | stretch, strengthen isometrically, and then strengthen isotonically |
| what is facilitated stretching | contracting another muscle that will help the muscle you are trying to contract, fire even faster |
| In the upper extremity, the anterior muscles of the right arm are paired with what muscles for facilitated strengthening | posterior muscles of the left arm |
| in the lower extremity, the anterior muscles of the right leg are paired with what muscles for facilitated strengthening | posterior muscles of the left leg |
| when considering both extremities, the anterior muscles of the right arm are paired with what muscles for facilitated strengthening | anterior muscles of the left leg |
| what is the recovery time for acute inflammation | 48-72 hours |
| what are the s&s of acute inflammation | pain, swelling, heat & redness, loss of function |
| what is the treatment for acute inflammation | ice, gentle adjustment, immobilization, physiotherapy |
| what is the goal of the acute inflammatory stage | stop inflammation |
| what is the recovery time for tissue repair | 48 hrs - 6 weeks (healing) |
| what are the s&s for the tissue repair stage | decrease S&S of the acute phase, inflammation, initiate tissue repair |
| what is the treatment for the tissue repair stage | adjustment, continuous passive motion, submaximal limited ROM resistance, back/neck exercises |
| what is the goal for the tissue repair stage | tissue healing, facilitate collegen w/o stressing the injured site, decrease scar formation, decrease pain |
| what is the recovery time for the remodeling phase | 3 wks-12 months |
| what are the S&S for the remodeling stage | decrease pain, increase ROM, Increase stability |
| what is the treatment for the remodeling stage | adjustment, maximal active resistance exercis3e, activity stimulation |
| what is the goal for the remodeling stage | maximal repair: soft tissues, ROM, strength, function |
| What is the time frame for cryotherapy | 10-20 min |
| what is the time & frequency for cryotherapy of the cervical spine, wrist, elbow, hand, shin, foot, & ankle | 10 min, 2-4x/day (min)- 1/hr (Max) |
| what is the time & frequency for cryotherapy of the t-spine, shoulder, knee | 15 min, 2-4x/day (min) - 1/hr (max) |
| what is the time & frequency for cryotherapy to the l-spine, pelvis, thigh | 20 min, 2-4x/day (min)- 1/hr (max) |
| what is the time & frequency for cryotherapy for pain control | 4-5 min, every 30 min |
| what is the standard rule for time & frequency of cryotherapy | 20 min every 2 waking hours |
| in the repair stage what is the standard protocol for PT | slow pace/short range 3 sets/6 reps 2/day (painless) |
| in the remodeling stage what is the standard protocol for PT | slow pace/full range 3 sets/ 6+ reps 2/day |
| what is the action for massage | mechanical: kinetic & friction |
| what is effleurage | stroking distal to proximal ( beginning & end of massage) |
| what is pressure massage | nimmo is type of massage that applies pressure on acupressure points (trigger) |
| what is petrissage | deep kneading of skin w/ large folds |
| what is pincement massage | grasp w/ quick releases |
| what is roulment | raise large fold of skin & roll twd head |
| what is tapotement | percussion w/ knife edge |
| what are the 5 types of tapotement | slapping, pounding, hacking, cupping (for cystic fibrosis), tapping (for childre, upper respiratory) |
| when is vibration massage used | in extremities only |
| what is the purpose of TFM (transverse friction massage) | breaks adhesions in muscles, ligaments, & joint capsule. Decrease chemical cross linking |
| what is the effect of effleurage | sedative |
| what is the amount of time effleurage is performed | at lease 5 min, max 15-20 |
| what is the dr's position for effleurage | fencer's stance facing cephalad |
| which way do the fingers point when doing a pressure massage | point laterally w/ palms facing the midline. Push down & laterally w/ calcaneal contact. While maintaining palmar contact, pull medially w/ fingers. |
| what regions should a pressure massage be performed | lumbar & pelvic |
| what is the effect of a pressure massage | increase circulation & lymph drainage |
| what is the amount of time a pressure massage should be done | 30-40 presses/min; max 5 min |
| what is the dr's position for a pressure massage | toggle stance, feet parallel, knees into table, at level of pts pelvis |
| what is the procedure for a petrissage massage | while squeezing the skin, raise a large fold of skin btw your thumb & other fingers. Push thumbs toward the fingers & release. Both hands can squeeze at the same time, or alternate |
| what is the effect of petrissage | stimulatory, breaks up adesions |
| what is the amount of time that petrissage is performed | 30-40 presses/min; max 5 min |
| what is the dr's position for petrissage | fencer stance at side of table facing cephalad |
| what is the procedure for pincement massage | using your right & left hands alternately, grasp & release (quickly) the skin w/ your fingers. |
| what is the effect of pincement massage | stimulatory, breaks up adhesions |
| what is the amount of time that pincement massage should be done | 30-40 presses/min; 5 min max |
| what is the dr's position for pincement massage | fencer stance facing cephalad |
| what is the procedure for roulement massage | raise a large fold of skin between thumb & other digits. begin at the base of the spine & roll the skin in a cephalid direction, along the paraspinals. |
| what is the effect of roulement massage | therapeutic, relaxing, breaks up superficial fascial adhesions, chronic subluxation can be revealved if contact is lost. |
| what is the amount of time for roulement | no more than 3 min |
| what is the dr's position for roulement massage | fencer stance facing cephalad |
| what is the procedure for tapotement massage | knife edge, contact the skin, keep fingers separated, flexed & relaxed.Dr. leans over contact points, w/ both elbows in to the sides. W/ the sides of the 5th digits striking 1st, the rest of the digits quickly fall together in percussive manner. deliver s |
| What is the effect of tapotement massage | stimulatory |
| what is the amount of time tapotement massage is done | 100-200 strokes/min; performed quickly |
| what is the dr's stance for tapotement massage | toggle stance, feet parallel, knees into table, at level of the contact area (spine) |
| what is the procedure for cupping massage | Both arms are pronated when cupped hands make contact with the skin. The motion is performed by flexion & extension of the forearms at the elbow jts. Another form of percussion |
| what is the effect of cupping massage | stimulatory |
| what is the dr's stance for cupping | toggle stance, feet parallel, knees into table, at level of contact area (spine) |
| How does the vibratory therapy stimulate the spinal centers | by deep, rapid, short-duration percussion, applied either by hand or by a percussion type vibrator |
| what are the guidlines for the vibratory therapy | do on SPs, rate 1-2 impulses/sec for 20 sec w/ 30 sec rest intervals. Stimulation (3 min or longer)appears to fatigue excitability & produces an inhibatory effect |
| What is the effect initiated by stimulation of the C1-C2 spinal level | vagal response of increased gastric secretion & peristalsis. Increased nasal buccal pulmonary mucosal secretions |
| What is the effect initiated by stimulation of the C3 spinal level | Phrenic influence to increase depth of diaphragmatic excursions. Note that C3 inhibition is helpful in chronic cough & hiccups |
| What is the effect initiated by stimulation of the C4-C5 spinal level | Lung reflex contraction (used in expiratory dypnea, emphysema) & pulmonary vascular vasoconstriction |
| What is the effect initiated by stimulation of the C6-C7 spinal level | Reflex center for increasing generalized vasoconstriction & myocardial tone |
| What is the effect initiated by stimulation of the T1-T3 spinal level | Lung reflex dilation (inhibitory dyspnea), relax the stomach body & contract the pylorus; inhibit heart action (antitachycardia reflex) & gastric hyper mobility |
| What is the effect initiated by stimulation of the T4 spinal level | Cardia & aortic dilation & inhibits viscerospasms |
| What is the effect initiated by stimulation of the T5 spinal level | pyloric & duodenal dilation when applied to the right side |
| What is the effect initiated by stimulation of the T6 spinal level | gallbladder contraction when applied to the right side |
| What is the effect initiated by stimulation of the T7 spinal level | slight visceromotor renal dilation when applied bilaterally & stimulate hepatic function |
| What is the effect initiated by stimulation of the T8-T9 spinal level | Gall duct dilation |
| What is the effect initiated by stimulation of the T10-T11 spinal level | Slight visceromotor renal contraction, enhance pancreatic secretion, relax intestines & colon, & stimulate adrenals when applied bilaterally to initiate splenic contraction (& circulate RBC'S) when applied to the left side |
| What is the effect initiated by stimulation of the T12 spinal level | Prostate contraction & tone of the cecum & bladder sphincter |
| What is the effect initiated by stimulation of the L1-L3 spinal level | Uterine body, round ligament & bladder contraction, pelvic vasoconstriction, vesicular sphincter relaxation |
| What is the effect initiated by stimulation of the L4-L5 spinal level | Sigmoidal & rectal contraction, increase tone of lower bowel |
| what is the angle of application for superficial oscillatory effect of vibratory therapy | parallel |
| what is the angle of application for deeper percussive effect of vibratory therapy | perpendicular |
| what is the angle of application for mixture of superficial oscillatory & deeper percussive effect of vibratory therapy | varied |
| What are the effects of high velocity vibratory therapy | analgesia, decrease trigger points, good on muscles, good on periarticular tissues, pre-exercise warm-up, relax spacticity, superficial circulatory stimulation |
| what are the effects of medium velocity vibratory therapy | same as high, but used when milder effect is desired |
| what are the effects of low frequency vibratory therapy | congestion, edema, hyperesthesia, hypomyotonia, postural drainage, stasis |
| what is the rule for crutches | 2-10-30 2- fingers width down axilla, 10- in ches from lateral malleolus to end of crutch on ground, 30-degree angle between side of body |
| what are the 3 types of cervical supports used & what are they used for | soft collar- no ligament laxity firm collar-moderate ligament laxity Philadelphia collar-sever lig laxity (rust's sign) |
| what is a milwaukee brace used for | thoracic scoliosis 20-40 degrees worn 23 hrs/day (>40-refer for surgery) |
| what is an orthosis | an orthopedic device aaploed in treatment of physical impairment |
| what are the 4 general rules for application of a brace | position body part properly, often at "physiological rest" Comfortable, but firm avoid pressure on nerves, vessels, vital structures avoid friction/skin irritation |
| what are the contraindications for bracing | depend on time & nature of pt's condition: if forms adhesions or fibrosis due to chronic lack of motion, if causes vascular stasis, congestion, or ischemia, if results in atrophy/atonicity, if sustained position causes undesired stretching/contrac of CT |
| what are the 4 categories of cervical orthotics | devises cervical collars, cervical braces, cervico-thoracic orthosis (CTO), & halo devices |
| what type of brace is almost as confortable as a soft collar, is more effective in limiting flexion/ext to 30% normal, less effective in limiting lateral bending 67% normal & limits rotation to 43% normal | philadelphia brace |
| what type of brace is as effective as a philadelphia collar, but is far more comfortable because it rests on the clavicle | firm polyethylene collar |
| what are the 2 types of cervical braces | poster brace & somi brace |
| what is a poster brace | has 4 posters, provides more cervical support than collar, less than a CTO, & effective in controlling cervical flexion |
| what is a somi brace | controls upper cervical motion, not good for lower cerv., easy to apply & adjust, uncomfortable for bedridden |
| What is a CTO | most effective for lower cerv(C5-T1), less comfortable than braces, harder to adjest, attaches to thorax via chest strap, more rigid |
| what does the rigidity of a CTO depend on (3) | length of torso attachment, metal vs leather for occiput & mandibular supports, & malleable vs rigid shoulder straps |
| what are the 3 types of CTO's | jewett j-21: 2 poster CTO, rigid metal bands from sternal pad, across shoulders & down back pERTERSON cto: LARGER SUPPORTS, INCLUDES FOREHEAD STRAP mINERVA TYPES: custom molded, total contact |
| what is a halo traction device | skull fixed via invasive pins which are secured to metal halo & attached by metal struts to body jacket. ONLY orthosis restricting motion btw occ & C!; best to restrict motion btw C1&C2: restricts total cervical lat bending to 12 degrees |
| what are the 3 main purposes of orthopedics as stated by Finneson (lumbar) | limit spinal motion, correct posture, & decrease mechanical stress on the lower lumbar spine |
| what is the definition of scoliosis | a lateral curvature of the spine ( usually accompanied by rotary deformity) that is 20 degrees or greater |
| what classifies scoliosis as rotary | SP rotation to concavity |
| what classifies scoliosis as simple | SP rotation into convexity |
| if a rotary scoliosis you never adjust with a _________ contact | Spinous |
| if a simple scoliosis contact the _____on the high side of the rainbow | spinous process |
| what classifies a functional scoliosis | adams sign-curve goes away usually reversible, due to mechanical basis, scoliosis decreases when gravity is removed or causative factor is removed, lateral bending posture corrects |
| if scoliosis is <20 | DC can treat no referral needed |
| if scoliosis is 20-40 decgrees | send to orthopedist for bracing (Milwaukee/copes), continue to treat |
| if scoliosis is >40 | surgical candidates: harrington rods or dwyer procedure (discs removed, screws inserted, wire connected & shortened to compress bone) |
| How do you monitor the progression of scoliosis (what sign) | rissers sign- bone grows over iliac crest capping- grows lateral to medial (asis to psis) begins girls-14, boys 16 takes 1 yr (2 yrs more to fuse) |
| what is the grading system for the risser's sign | 1+= 25%, 2+= 50%, 3+= 75%, 4+= 100%, 5+= fused |
| what is the xray protocol for monitoring scoliosis | take xrays every 3 months, for 3 years after risser sign progression if >20 refer for bracing (or 18-21 degrees in 3 months if increases 5 degrees or more refer out (13-18 degrees in 3 months) once iliac crest fuses, xray 1/yr for the next 5 yrs. |
| what are the physiological effects of traction | decrease intra-discal pressure, increase IVF space, break adhesions, alter curve, break muscle spasms, gliding of facet joints |
| what type of traction, continuous or intermittent, is good for: facet syndrome, disc syndrome, IVF encoachment, radiating pain & radiculitis | intermittent |
| what are the main reasons for traction | rest by immobilization, overcome muscle spasms, seperate bony surfaces |
| what is the classification of traction methods according to duration (3) | continuous: several hours, days sustained: shorter periods (1/2 hour) Intermittent: off & on for brief periods (<1/2 hour) |
| how long does it take for scar tissue to form completely | 3 weeks |
| what will occur if the inflammatory stage persists | excessive fibrogenesis, which resuts in tissue damage |
| what is the pneumonic for the goal of the inflammatory stage | PRICES: protect, rest, ice, compression, elevation, & support |
| what is the mail goal for the subacute/fibroblastic repair phase | continue pain control, remove any persistent inflammation/swelling, increase circulation, increase healing & begin ROM & strengthening |
| the portion of the electromagnetic spectrum past the red visible light are called ______ & are associated with _____ changes | infrared, thermal |
| the portion of the electromagnetic spectrum past the violet region are called ____ & are associated with ____ changes | ultraviolet, chemical |
| what type of currents affect nerve & muscle tissue & have the longest wavelengths & lowest frequencies | electrical stimulating currents |
| Shortwave & diathermies are considered to be what type of frequency currents | high frequency |
| which has a deeper penetration, shortwave or microwave diathermy | microwave |
| what is the penetration of infrared modalities | 1 com or less, superficial |
| reflected | bounce off |
| refracted | direction of travel altered |
| transmitted | goes through the tissueq |
| absorbed | thru tissue & stops |
| what are the general contraindications for ALL modalities | HIM: sytemic Hemorrage, Infection w/ suppuration, Malignancy |
| what are the general contraindications for ALL heating modalities | Diabetes mellitus, avtive TB, encapsulated swelling, decreased thermal sensations, over low back/pelvis during pregnancy |
| what are the general contraindications for ALL electrical modalities | over brain, eyes, heart, carotid sinus, lowback/pelvis during pregnancy, open wounds, pacemakers decreased sensation for direct current (monophasic) |
| what are the physiological effects of UV | skin stuff (anti-fungal, antibacterial, antiviral) vit D production |
| what are the indications for UV | skin conditions, bone conditions where increased Vit D is indicated |
| what are the contraindications for UV | HIM, lupus, acute eczema, hyperthyroidism, sarcoidosis, herpes |
| Is penetration of UV superficial or deep | superficial, 1-2 mm * the most superficial of all modalities |
| what is the erythema patch test | for UV modalities. 5 penny size holes, lamp 30-36" from skin, cover first hole after 15 sec & then 5 sec intervals for each hole thereafter determine time of mild erythermal dose take ~40 seconds to find it |
| what are the 5 stages of burn | SED= sub-eryhermal dose, no reddening MED- mild erythermal dose,reddening w/o desquamation 1st-reddening, slight desquam. 2nd-considerable reddening w/ itching, burning, desquam., blister 3rd- intense rxn w/ swelling, edema, blister 4th-passes skin - |
| what degree is required to be considered a full thickness burn | 2nd |
| what is the treatment time for UV | start w/ MED, increase 15 sec easch visit to max of 3 minutes further care needed: fdecrease distnace by 2" each visit, minimum distance 18" |
| what is the max dosage of UV | 3 minutes, 18" |
| what is the physiochemical effect of positve pole (anode) | attracts acids, repels bases, attracts oxygen, repels hydrogen, corrodes metal (oxidationj) |
| what is the physiochemical effect of negative pole (cathode) | repels acids, attracts babes (alkaloids), repels oxygen, attracts hydrogen, no oxidation, |
| what is the physiologic affect of positive pole (anode) | hardens tissues, decreases nerve irritability, produces vasoconstriction, ischemia, decreased bleeding, dehydrates tissues, acute pain relief |
| what is the physiologic affect of the negative pole (cathode) | sofenes tuissues, increases irritability, vasodilation, hyperemia, increased bleeding, hydrates tissues, may increase pain in acute but decrease in chronic |
| positive pole (anode) is equivelent to ___ | ice |
| Negative pole (cathode) is equivelent to___ | heat |
| in electrodiagnosis, what what the response of muscle & nerve when stimulated by LVG w/ partial reaction of degeneration | Muscle & nerve normal |
| in electrodiagnosis, what what the response of muscle & nerve when stimulated by faradic w/ partial reaction of degeneration | Muscle & nerve slow |
| in electrodiagnosis, what what the response of muscle & nerve when stimulated by LVG w/ total/full reaction of degeneration | Muscle-sluggish, nerve-none |
| in electrodiagnosis, what what the response of muscle & nerve when stimulated by faradic w/ total/full reaction of degeneration | Muscle & nerve: none |
| in electrodiagnosis, what what the response of muscle & nerve when stimulated by both LVG & faradic w/ absolute/complete reaction of degeneration | Muscle & nerve none |
| what is the recovery time for partial reaction od degeneration | 2 weeks |
| what is the recovery time for total/full reaction of degeneration | 3 weeks-1 yr |
| what is the recovery time for absolute/complete reaction of degeneration | never |
| what is the frequency for IF | medium |
| what is the frequency for LVG | low |
| what is the frequency for LVPC | Low |
| what is the frequency for HVPC | low |
| what is the frequency for tens | low |
| what is the frequency for sinewave | low |
| what is the frequency for faradic | low |
| what is the frequency for microcurrent | ultra low |
| what is the current form for LVG | monophasic/DC (galvanic) |
| what is the current form for LVPC | monophasic/DC (galvanic) |
| what is the current form for HVPC | monophasic/DC (galvanic) |
| what is the current form for TENS | Biphasic/AC, pulsed |
| what is the current form for sinewave | Biphasic/AC |
| what is the current form for faradic | biphasic/AC |
| what is the current form for microcurrent | monophasic/DC (galvanic) Biphasic pulsed |
| what is the waveform for IF | sinusoidal |
| what is the waveform for LVG | rectangular |
| what is the waveform for LVPC | rectangular |
| what is the waveform for HVPC | triangular-twin peaked |
| what is the waveform for tens | rectangular |
| what is the waveform for sinewave | sinusidal(nonpolar) |
| what is the waveform for faradic | triangular (slightly polar) |
| what is the waveform for microcurrent | rectangular |
| what are the primary actions for IF | electrokinetic, electroanalgesic |
| what are the primary actions for LVG | electrokinetic, electrochemical, electroanalgesic, iontophoresis |
| what are the primary actions for LVPC | electrokinetic, electrochemical, electroanalgesic |
| what are the primary actions for HVPC | electrokinetic, electrochemical, electroanalgesic |
| what are the primary actions for tens | electroanalgesic |
| what are the primary actions for sinewave & faradic | electrokinetic |
| what are the primary actions for microcurrent | electroanalgesic, tissue healing(primarily) |
| Ohm's law | the current in an electrical circuit is directly proportional to the voltage & inversely proportional to the resistance |
| electrical power is measured in | watts |
| watts= | voltage x amperes |
| amplitude is | intensity |
| pulse is | an individual waveform, may be comprised of 1 or 2 phases |
| phase is | portion of wave that rises above or goes below the baseline |
| pulse duration is | length of time that the current is flowing & is a representation of the duration of the pulse |
| pulse period is | the eriod of time from the start of one pulse to the beginning of the next pulse (may contain a interpulse period) |
| interrupted modulation | current flows for some period & then turned off for a period of time, usually multiple seconds |
| Burse modulation | pulsed current for a short duration followed by an off time of short duration |
| coulombs law | unlike charges attract, like charges repel |
| kirchoffs principle | current will seek out the path of least resistance |
| if the cell membrane is repeatedly subjected to stimpulation that occurs faster than the cell membrane can repolarize, the membrane will become partially insensitive to the stimulus. This is called | wedensky inhibition (nerve block) |
| "A" motor & sensory fibers are the ___ & conduct the most___ | thickest, rapidly |
| "C" fibers are the ___& conduct the _____. They are associated with____ | thinnest, slowest, pain formation |
| increasing the intensity of the stimulus will result in ____ penetration | deeper |
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JRW
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